Prolonged post-washing in ethanol decreases bond strength of additively manufactured crown materials

OBJECTIVES

This study aimed to investigate the effect of post-washing duration and crown thickness on the bond strength between additively manufactured crown materials and dental cement in vitro.

METHODS

Rectangular-shaped specimens of two thicknesses (1.5 and 2.0 mm) were additively manufactured from permanent VarseoSmile Crown (VC) and long-term temporary NextDent (ND) materials. The specimens were post-washed (n = 160) in ethanol for 5 min, 10 min, 1 h, and 8 h then cemented with dual-cure resin cement. Twenty PMMA (TC) were milled as a control. A chevron-notch test was performed to measure the maximum load until failure (N). Interfacial bond strength (J/m2) was calculated and statistically analysed. The mode of failure was analysed by scanning electron microscopy (SEM).

RESULTS

There was a significant difference in the bond strength between all groups (p < 0.01). VC at 1.5mm thickness post-washed for 10 min showed the highest mean bond strength (1.77 ±0.96 J/m2) while VC at 2.0mm thickness post-washed for 8 h showed the lowest (0.22 ±0.10 J/m2). Exposure to ethanol for 8 h resulted in lower bond strength. Within the type of material, there were no differences in bond strength between the thicknesses when post-washed for the same duration.

CONCLUSIONS

Prolonged post-washing of AM crown materials can significantly decrease the bond strength to resin cement. There were no differences between the permanent and long-term temporary AM materials. When post-washed for 5 min, AM materials observed comparable or higher bond strength values compared to PMMA.

CLINICAL SIGNIFICANCE

The output of this research serves as a guide for dental practitioners, emphasising the importance of adhering to correct post-washing procedures for optimal bond strength of additively manufactured crown materials.

Factors influencing the bond strength of additively manufactured crown materials in dentistry: A systematic review of in vitro studies

OBJECTIVE

The purpose of this systematic review was to investigate how different interventions can impact the bond strength of additively manufactured crown materials after cementation.

DATA/SOURCES

Four online databases Ovid MEDLINE, Scopus, Web of Science and Google Scholar were searched up to January 2023. Inclusion criteria were English-language publications, full-text, and in vitro studies only. Exclusion criteria were studies that did not assess the bonding of an additively manufactured crown material to cement or did not conduct any bond strength tests. An assessment of risk of bias was done in accordance with a modified Consolidated Standards of Reporting Trials (CONSORT) checklist. Each study was analysed and compared based on the interventions and bond strength results.

STUDY SELECTION

Six studies satisfied the inclusion and exclusion criteria, five of which evaluated photopolymerised resin and one that tested zirconia manufacturing via 3D printing. All studies observed a low risk of bias. The interventions applied included the type of surface pretreatments, airborne-particle abrasion pressure, cement type, taper of crown, and artificial aging. Three studies compared the bonding performance to milled materials.

CONCLUSIONS

The bond strength of crown materials additively manufactured from photopolymers presented high values and are comparable to milled materials. The systematic review demonstrated there was no definite superior cement type, but airborne-particle abrasion with alumina was generally recommended. There is a clear gap in the literature regarding the bond strength of additively manufactured crowns. Therefore, further research is necessary to evaluate its clinical applicability for permanent restorations.

CLINICAL SIGNIFICANCE

Factors influencing the bond strength of additively manufactured crown materials should be evaluated so dental professionals can adopt procedures that promote the strongest bond.

Influence of different post-processing methods on the dimensional accuracy of 3D-printed photopolymers for dental crown applications - A systematic review

OBJECTIVES

To perform a systematic review that provides an overview of the current literature on the influence of different post-processing methods on the accuracy of additive-manufactured (3D-printed) photopolymer crown materials, and whether more research is needed.

MATERIALS AND METHODS

The search used three online databases, Ovid (MEDLINE), Scopus and Web of Science which were screen for publications that involved assessing dimensional accuracy in post-processing of 3D printed dental crown materials. Publications that were literature reviews, abstracts, written in a language different from English, or publications that did not assess dimensional accuracy were excluded.

RESULTS

The included articles were published between 1995 and 2023. After the removal of duplicates using Endnote, 135 studies remained for further screening, 13 were selected for full-text analysis, and 7 studies were included in the systematic review. A total of 7 articles were examined and categorised based on several factors, such as the type of material, number of specimens per group, print layer thickness, print angle of specimens, 3D printer used, properties of the specimens studied, and the method of analysing the accuracy of the specimens.

CONCLUSION

It was found that post-processing washing times outside the prescribed instruction for use (IFU) may have an impact on the physical and biocompatibility characteristics of the material. Studies focusing on inert mediums during post-processing require more detailed investigation. The use of different post-curing conditions does not significantly affect the materials dimensional accuracy.

Accuracy of digitally coded healing abutments: A systematic review

The aim of this systematic review was to evaluate the in vitro accuracy of dental implant impressions taken using digitally coded healing abutments (CHAs) compared with impressions taken with conventional techniques (CI) and/or within the CHA group at varying degrees of angulations for multiple implant units. Two independent reviewers conducted a systematic electronic search in the MedLine, PubMed, Google Scholar, Cochrane Library, Web of Science, and Scopus databases. Some of the employed key terms, combined with the help of Boolean operators, were: "digitally coded healing abutments", "encode healing abutment", "dental implants", "impression accuracy", "digital impression", and "conventional impression". Publication dates ranged from January 2010 to November 2022. A total of 7 articles fulfilled the inclusion criteria: 6 studies compared the accuracy of CHA with conventional pick-up impression techniques, and one study only used CHAs at different angulations and heights to compare accuracy within the group. The results were divided into Group A (elastomeric impression of CHA) and Group B (CHA + Intraoral scanner). According to the results of this systematic review, elastomeric impression of CHA performed poorly when compared to CI for multiple implants, although an intraoral scan of CHA appears to be more accurate. Within the CHA group, the angulation and visible height of CHA play a significant role in impression accuracy. However, more studies are needed before CHA can be recommended for all non-parallel multiple implant-supported restorations.

Factors influencing the dimensional accuracy of additively manufactured dental models: A systematic review of in vitro studies

OBJECTIVES

This study aims to systematically review the literature and evaluate the effect of post-printing factors such as aging, heat, appliance fabrication and storage on the dimensional accuracy of full-arch dental models manufactured by additive manufacturing (AM) technology for the intended use of working model purposes.

MATERIALS AND METHODS

Three online databases, Medline (Ovid), Scopus and Web of Science were screened and last searched in March 2023. In-vitro studies and publications involving any distortions and shrinkage to the additively manufactured (AMed) model after printing and post-processing were included. However, literature reviews, abstracts, publications in a language different from English, or publications not testing a dental model with an arch or dentition were excluded. The references cited in the studies included were also checked via Google Scholar to identify relevant published studies potentially missed.

RESULTS

The systematic search identified and screened 769 different studies after the removal of duplicates. After applying inclusion and exclusion criteria, a total of 30 relevant titles and abstracts were found, yielding six final selections after full-text screening. Four out of the six studies evaluated the effect of both storage and aging on the dimensional accuracy of AMed dental models. The other two studies assessed the dimensional accuracy after the fabrication of thermoformed and vacuum-formed appliances on the AMed dental model.

CONCLUSIONS

AMed models can be utilised as working models on the condition that specific printing parameters are followed and additional model design features are employed. No definitive conclusions can be drawn on standardised methods to assess the dimensional accuracy of AMed dental models after storage, aging and appliance fabrication. In addition, there is no consensus on specific storage periods for an AMed model. Majority of study designs removed the palatal region to create a horseshoe shaped model, making the results less applicable to a working model scenario requiring the palate for retention purposes. The parameters investigated on AMed models include storage, aging, and appliance fabrication through thermoforming and vacuum-forming. Printing densities of solid models and wall thickness of hollow models were shown to influence the accuracy of AMed models. Dimensional accuracy of AMed models have been shown to be affected during appliance fabrication through thermoforming and vacuum-forming in certain conditions.

SIGNIFICANCE

There is a clear need of standardisation when manufacturing AMed dental models for working model purposes. The current methods investigated in this study lack established protocols to accurately manufacture the AMed models, and effectively store and utilise an AMed dental model for fabrication of orthodontic and prosthodontic appliances.

Efficacy and safety of Botulinum toxin A for improving esthetics in facial complex: A systematic review

AIM

To evaluate efficacy and safety of Botulinum toxinA for improving esthetics in the facial complex and correlating them to the dosage and side effects through a systematic review.

METHODS

A literature search was performed using PubMed, Medline, Web of Sciences, and Scopus databases. Quality of studies was appraised through the GRADE system. This review follows the 'Preferred reporting items for systematic review and meta-analysis protocols' (PRISMA-P) 2015 statement. Efficacy was analyzed through improvement rate and effect sizes. Graphical comparison of efficacy and ocular adverse effects (adverse effects around the eye) at various anatomical locations was made by calculating the average improvement rate and adverse events.

RESULTS

Twenty-five studies were included in this systematic review after application of the inclusion criteria. Moderate to severe cases in glabellar, lateral canthal, and forehead regions showed higher improvement rates between 20U to 50U, with an effect lasting up to 120 days. Gender and age seemed to have a direct effect on efficacy. Headaches were the most common adverse effect, followed by injection site bruising; all adverse effects resolved within 3-4 days.

CONCLUSIONS

Treatment with Botulinum toxinA to enhance esthetics of facial complex is efficient and safe at all recommended dosages. Presence of complexing proteins influenced the efficacy of BoNT-A. undesirable muscular adverse effects around the eyes were more predominant when treating the glabellar region. There was no correlation found between the BoNT-A dosage and side effects, however, an increase in dosage did not always lead to an increase in efficacy.

Inhomogeneous superconductivity and quasilinear magnetoresistance at amorphous LaTiO3/SrTiO3 interfaces

We have studied the transport properties of LaTiO3/SrTiO3 (LTO/STO) heterostructures. In spite of 2D growth observed in reflection high energy electron diffraction, transmission electron microscopy images revealed that the samples tend to amorphize. Still, we observe that the structures are conducting, and some of them exhibit high conductance and/or superconductivity. We established that conductivity arises mainly on the STO side of the interface, and shows all the signs of the two-dimensional electron gas usually observed at interfaces between STO and LTO or LaAlO3, including the presence of two electron bands and tunability with a gate voltage. Analysis of magnetoresistance (MR) and superconductivity indicates the presence of spatial fluctuations of the electronic properties in our samples. That can explain the observed quasilinear out-of-plane MR, as well as various features of the in-plane MR and the observed superconductivity.

AB0082 INHIBITION OF TGFβ SIGNALING USING SB-505124 BLOCKS TH17 DIFFERENTIATION AND RESTORES THE TH17/TREG BALANCE IN VIVO, BUT DOES NOT SUPPRESS EXPERIMENTAL ARTHRITIS

Background:

TGFβ is an important growth factor that promotes the differentiation of T helper 17 (Th17) as well as regulatory T-cells (Treg). Due to its dual role, the potential of TGFβ as therapeutic target is unclear.

Objectives:

In this study we aimed to investigate the effect of inhibition of TGFβ signaling with the ALK5 inhibitor SB-505124 on human Th17 differentiationin vitro, on cytokine production by human rheumatoid arthritis (RA) synovial explants, and study the effects of local SB-505124 treatmentin vivoduring innate immune and Th17-driven experimental arthritis models.

Methods:

Magnetic sorted naïve human T cells were differentiated into Th17 cells with CD3/CD28 activation beads, IL-2, TGFβ, IL-1β, IL-23, αIFNƳ and αIL-4 for 6 days. Human RA synovial biopsies were cultured for 24h w/o 5µM SB-505124, and supernatant was analyzed by Luminex. T cell-independent SCW arthritis and Th17-driven IL-1/mBSA arthritis were induced in C57Bl6, and mice were treated with SB-505124 by daily intra-articular injections from day 0-4.

Results:

SB-505124 potently reduced human Th17 differentiationin vitroby decreasing IL-17 and RORƳt gene expression and IL-17 protein production. SB-505124 significantly suppressed IL-6 and TNFα protein production by human RA synovial explants. In addition, SB-505124 did not affect acute joint inflammation during SCW-arthritis (T-cell independent model). Interestingly, SB-505124 reduced Th17 levels in draining lymph nodes (dLN) during IL-1/mBSA arthritis while increased levels of Tregs were observed. Surprisingly, despite this skewed Th17/Treg balance, this did not result in suppression of joint inflammation and destruction in this Th17-driven arthritis model, whereas anti-IL-17 antibody treatment showed significant therapeutic effects.

Conclusion:

We revealed suppressive effects of SB-505124 on human Th17 differentiation and the Th17/Treg balance in arthritic mice. However, SB-505124 did not suppress joint inflammation and destruction. This indicates that despite the importance of TGFβ in Th17 differentiation, targeting TGFβ signaling is not enough to suppress experimental arthritis.

Disclosure of Interests:

None declared

THU0079 THE MICROBIOME OF NEW-ONSET RHEUMATOID ARTHRITIS (NORA) PATIENTS DRIVES TLR4-DEPENDENT TH17 RESPONSES

Background:

Intestinal microbiota plays a prominent role in shaping the T cell immune response. Increasing evidence suggests that the gut microbiota is perturbed in patients with RA, and a variety of animal models demonstrated involvement of (mouse) microbiota in arthritis development. This underlines the necessity of understanding whether and how indigenous human NORA-associated microbiota may trigger RA.

Objectives:

To comprehensively investigate the intestinal mucosa cytokine production and DC, T and B cell responses to human gut microbiota associated with new-onset RA.

Methods:

We utilizedin vitrocultures of mucosal-like DCs (differentiated from bone marrow cells) and primary splenic DCs, as well asex vivocultures of healthy human intestinal biopsies, cultured in the presence of heat-killed fecal microbiota from either NORA or control donors. Furthermore, we performed studies in humanized mice carrying intestinal NORA microbiota, to study the effect on immune response during homeostasis and upon joint inflammation during collagen-induced arthritis (CIA).

Results:

In 24h DC cultures, NORA fecal microbiota more potently induced the expression of co-stimulatory molecules CD40 and CD80, and this enhanced DC maturation was partially mediated through TLR4 as demonstrated using the TLR4 antagonist TAK242. Interestingly, HC and NORA fecal microbiota differentially induced IL-12 and IL-6 production, with significantly enhanced IL-6 and reduced IL-12 secretion by the NORA microbiome. Furthermore, inex vivocultures of human ileum biopsies, the production of IL-1 and IL-33, as well as IL-23/Th17 cytokines IL-23, IL-22, and GM-CSF, were significantly increased by NORA-derived microbiome. Interestingly, in the small intestine lamina propria (SILP) of NORA-colonized mice, we observed enhanced Th17 polarization, increased innate GM-CSF expression and higher B cell CD40 and IgA levels during homeostasis. To study whether colonization with HC and NORA microbiota alters arthritis development, humanized mice and controls (mock, autologous, HC and NORA microbiota) were used in a CIA experiment. Macroscopic scoring of the arthritis severity at weekly intervals demonstrated that arthritis severity was significantly enhanced in NORA-colonized mice compared to HC-colonization and mock controls.

Conclusion:

Our data reveal that NORA microbiota, in addition to the previously described Th17 differentiation, induce higher levels of GM-CSF and B cell IgA in LP and have increased potential to aggravate arthritis through the activation of TLR4.

References:

[1]Scher et al., eLife 2013; Maeda Y et al., Arthritis & rheumatology 2016; Zhang X et al., Nature medicine 2015; Chen J et al., Genome Med 2016

Disclosure of Interests:

Marije Koenders: None declared, Heather Evans-Marin: None declared, Joyce Aarts: None declared, Parvathy Girija: None declared, Rebecca Rogier: None declared, Sergei Koralov: None declared, Julia Manasson: None declared, Peter van der Kraan: None declared, Shahla Abdollahi-Roodsaz: None declared, Jose Scher Consultant of: Novartis, Janssen, UCB, Sanofi.

TGFβ-mediated expression of TGFβ-activating integrins in SSc monocytes: disturbed activation of latent TGFβ?

Introduction

The pathophysiology of systemic sclerosis (SSc) is closely linked to overactive TGFβ signaling. TGFβ is produced and circulates in latent form, making its activation crucial for signaling. This activation can be mediated via integrins. We investigated the balance between active and latent TGFβ in serum of SSc patients and investigated if this correlates with integrin expression on monocytes.

Methods

A TGFβ/SMAD3- or BMP/SMAD1/5-luciferase reporter construct was expressed in primary human skin fibroblasts. Both acidified and non-acidified sera of ten SSc patients and ten healthy controls were tested on these cells to determine total and active TGFβ and BMP levels respectively. A pan-specific TGFβ1/2/3 neutralizing antibody was used to confirm TGFβ signaling. Monocytes of 20 SSc patients were isolated using CD14+ positive selection, and integrin gene expression was measured using qPCR. Integrin expression was modulated using rhTGFβ1 or a small molecule inhibitor of TGFBR1: SB-505124.

Results

SSc sera induced 50% less SMAD3-reporter activity than control sera. Serum acidification increased reporter activity, but a difference between healthy control and SSc serum was no longer observed, indicating that total TGFβ levels were not different. Addition of a pan-specific TGFβ1/2/3 neutralizing antibody fully inhibited SMAD3-reporter activity of both acidified and not-acidified control and SSc sera. Both HC and SSc sera induced similar SMAD1/5-reporter activity, and acidification increased this, but not differently between groups. Interestingly, expression of two integrin alpha subunits ITGA5 and ITGAV was significantly reduced in monocytes obtained from SSc patients. Furthermore, ITGB3, ITGB5, and ITGB8 expression was also reduced in SSc monocytes. Stimulation of monocytes with TGFβ1 induced ITGA5 and ITGAV but lowered ITGB8 expression, whereas the use of the TGFβ receptor inhibitor SB-505124 had the opposite effect.

Conclusion

Total TGFβ serum levels are not different between SSc patients and controls, but TGFβ activity is. This coincides with a reduced expression of TGFβ-activating integrins in monocytes of SSc patients. Because TGFβ regulates expression of these integrins in monocytes, a negative feedback mechanism possibly underlies these observations.

ICT in Health Care: Sociotechnical Approaches

The importance of the social sciences for medical informatics is increasingly recognized. As ICT requires interaction with people and thereby inevitably affects them, understanding ICT requires a focus on the interrelation between technology and its social environment. Socio-technical approaches increase our understanding of how ICT applications are developed, introduced and become a part of social practices. Sociotechnical approaches share several starting points: 1) they see health care work as a social, ‘real life’ phenomenon, which may seem ‘messy’ at first, but which is guided by a practical rationality that can only be overlooked at a high price (i.e. failed systems). 2) They see technological innovation as a social process, in which organizations are deeply affected. 3) Through in-depth, formative evaluation, they can help improve system design and implementation.

Same Systems, Different Outcomes

Objectives: To compare the outcome of the implementation of computerized physician order entry (CPOE) systems in two Dutch hospitals.

Methods: Qualitative research methods, including interviews in both hospitals, observations of system in use, observations of staff meetings and document analysis were used to understand the implementation of CPOE. The transcribed texts and implementation documents were analyzed for relevant concepts.

The transcripts and field notes were analyzed using a heuristic success and failure model with medical work as the primary focus.

Results: Occasions that determined the outcome of the implementation were classified according to factors that may influence the success or failure of implementing systems.

Conclusions: The themes and patterns that emerged from the data helped validate the concept of medical work as the primary focus of our analysis model; in addition the concept of a support base necessary to accept changes in medical work that result from introducing CPOE may help to understand the different implementation outcomes.

Imaging pulsed laser deposition growth of homo-epitaxial SrTiO3 by low-energy electron microscopy

By combining low-energy electron microscopy with in situ pulsed laser deposition we have developed a new technique for film growth analysis, making use of both diffraction and real-space information. Working at the growth temperature, we can use: the intensity and profile variations of the specular beam to follow the coverage in a layer-by-layer fashion; real-space microscopy to follow e.g. atomic steps at the surface; and electron reflectivity to probe the unoccupied band structure of the grown material. Here, we demonstrate our methodology for homo-epitaxial growth of SrTiO₃. Interestingly, the same combination of techniques will also be applicable to hetero-epitaxial oxide growth, largely extending the scope of research possibilities.

Striped nanoscale phase separation at the metal-insulator transition of heteroepitaxial nickelates

Nucleation processes of mixed-phase states are an intrinsic characteristic of first-order phase transitions, typically related to local symmetry breaking. Direct observation of emerging mixed-phase regions in materials showing a first-order metal–insulator transition (MIT) offers unique opportunities to uncover their driving mechanism. Using photoemission electron microscopy, we image the nanoscale formation and growth of insulating domains across the temperature-driven MIT in NdNiO₃ epitaxial thin films. Heteroepitaxy is found to strongly determine the nanoscale nature of the phase transition, inducing preferential formation of striped domains along the terraces of atomically flat stepped surfaces. We show that the distribution of transition temperatures is a local property, set by surface morphology and stable across multiple temperature cycles. Our data provide new insights into the MIT of heteroepitaxial nickelates and point to a rich, nanoscale phenomenology in this strongly correlated material.

Probing the evolution of mixed-phase states in materials offers unique insights into the microscopic mechanism of phase transitions. Here, Mattoni et al. report imaging of nanoscale formation and growth of insulating domains across the metal-insulator transition in NdNiO₃ thin films, uncovering a rich interplay between structural and electronic degrees of freedom.

Temperature dependence of spin pumping and Gilbert damping in thin Co/Pt bilayers

We report on the temperature dependence of the spin-pumping effect and the Gilbert damping in Co/Pt bilayers grown on Silicon oxide by measuring the change of the linewidth in a ferromagnetic resonance (FMR) experiment. By varying the Co thickness d(Co) between 1.5 nm and 50 nm we find that the damping increases inversely proportional to d(Co) at all temperatures between 300 K and 5 K, showing that the spin pumping effect does not depend on temperature. We also find that the linewidth increases with decreasing temperature for all thicknesses down to about 30 K, before leveling off to a constant, or even decreasing again. This behavior is similar to what is found in bulk ferromagnets, leading to the conclusion that in thin films a conductivity-like damping mechanism is present similar to what is known in crystals.

Controlled mechnical modification of manganite surface with nanoscale resolution

We investigated the surfaces of magnetoresistive manganites, La(1-x)Ca(x)MnO3 and La(2-2x)Sr(1+2x)Mn2O7, using a combination of ultrahigh vacuum conductive, electrostatic and magnetic force microscopy methods. Scanning as-grown film with a metal tip, even with zero applied bias, was found to modify the surface electronic properties such that in subsequent scans, the conductivity is reduced below the noise level of conductive probe microscopy. Scanned areas also reveal a reduced contact potential difference relative to the pristine surface by ∼0.3 eV. We propose that contact-pressure of the tip modifies the electrochemical potential of oxygen vacancies via the Vegard effect, causing vacancy motion and concomitant changes of the electronic properties.

Interface-induced room-temperature ferromagnetism in hydrogenated epitaxial graphene

We show ferromagnetic properties of hydrogen-functionalized epitaxial graphene on SiC. Ferromagnetism in such a material is not directly evident as it is inherently composed of only nonmagnetic constituents. Our results nevertheless show strong ferromagnetism with a saturation of 0.9μ(B)/hexagon projected area, which cannot be explained by simple magnetic impurities. The ferromagnetism is unique to hydrogenated epitaxial graphene on SiC, where interactions with the interfacial buffer layer play a crucial role. We argue that the origin of the observed ferromagnetism is governed by electron correlation effects of the narrow Si dangling bond states in the buffer layer exchange coupled to localized states in the hydrogenated graphene layer. This forms a quasi-three-dimensional ferromagnet with a Curie temperature higher than 300 K.

Giant magnetic susceptibility of gold nanorods detected by magnetic alignment

We have determined the magnetic properties of single-crystalline Au nanorods in solution using an optically detected magnetic alignment technique. The rods exhibit a large anisotropy in the magnetic volume susceptibility (Δχ(V)). Δχ(V) increases with decreasing rod size and increasing aspect ratio and corresponds to an average volume susceptibility (χ(V)), which is drastically enhanced relative to bulk Au. This high value of χ(V) is confirmed by SQUID magnetometry and is temperature independent (between 5 and 300 K). Given this peculiar size, shape, and temperature dependence, we speculate that the enhanced χ(V) is the result of orbital magnetism due to mesoscopic electron trajectories within the nanorods.

Mechanical control of electroresistive switching

Hysteretic metal-insulator transitions (MIT) mediated by ionic dynamics or ferroic phase transitions underpin emergent applications for nonvolatile memories and logic devices. The vast majority of applications and studies have explored the MIT coupled to the electric field or temperarture. Here, we argue that MIT coupled to ionic dynamics should be controlled by mechanical stimuli, the behavior we refer to as the piezochemical effect. We verify this effect experimentally and demonstrate that it allows both studying materials physics and enabling novel data storage technologies with mechanical writing and current-based readout.

Computerized provider order entry system--does it support the inter-professional medication process? Lessons from a Dutch academic hospital

OBJECTIVES

To assess the effects of a CPOE system on inter-professional workflow in the medication process.

METHODS

Twenty-three semi-structured interviews with physicians, nurses, and pharmacists were conducted in a Dutch academic hospital. In addition, the handwritten and system-generated documents used daily were collected for analysis. Data was analyzed on the basis of three conceptual themes in the inter-professional workflow: division of tasks, flow of information, and task coordination.

RESULTS

The CPOE system reorganized the existing work procedures, affecting the workflow among the three professional groups both advantageously and disadvantageously. The system resulted in the reassignment of tasks and reallocation of areas of expertise in the medication process. Moreover, patients' medication-related information became fragmented in both the paper records and in the electronic records, as well as in different professional domains. The system provided limited support for professional groups to coordinate their tasks temporally. It also made it difficult to build mutual intelligibility upon new changes in the medication plan. To integrate tasks, the professional groups had to bypass the system or add new steps and extra coordinative tasks.

CONCLUSION

We identified several workflow integration issues after the implementation of a CPOE system. Our insights into these issues can help ensure that the system design or redesign properly integrates all tasks, information, and areas of expertise of professional groups into those of the physicians.

Spin dynamics in a superconductor-ferromagnet proximity system

The ferromagnetic resonance of thin sputtered Ni80Fe20 films grown on Nb is measured. By varying the temperature and the thickness of the Nb the role of the superconductivity on the whole ferromagnetic layer in these heterostructures is explored. The change in the spin transport properties below the superconducting transition of the Nb is found to manifest itself in the Ni80Fe20 layer by a sharpening in the resonance of the ferromagnet, or a decrease in the effective Gilbert damping coefficient, showing that the superconductivity affects the macrospin of the ferromagnetic layer. We interpret this in terms of the spin-pumping model.

Critical voltage of a mesoscopic superconductor

We study the influence of a voltage-driven nonequilibrium of quasiparticles on the properties of short mesoscopic superconducting wires. We employ a numerical calculation based upon the Usadel equation. Going beyond linear response, we find a nonthermal energy distribution of the quasiparticles caused by the applied bias voltage. It is demonstrated that this nonequilibrium drives the system from the superconducting state to the normal state, at a current density far below the critical depairing current density.

Same systems, different outcomes--comparing the implementation of computerized physician order entry in two Dutch hospitals

OBJECTIVES

To compare the outcome of the implementation of computerized physician order entry (CPOE) systems in two Dutch hospitals.

METHODS

Qualitative research methods, including interviews in both hospitals, observations of system in use, observations of staff meetings and document analysis were used to understand the implementation of CPOE. The transcribed texts and implementation documents were analyzed for relevant concepts. The transcripts and field notes were analyzed using a heuristic success and failure model with medical work as the primary focus.

RESULTS

Occasions that determined the outcome of the implementation were classified according to factors that may influence the success or failure of implementing systems.

CONCLUSIONS

The themes and patterns that emerged from the data helped validate the concept of medical work as the primary focus of our analysis model; in addition the concept of a support base necessary to accept changes in medical work that result from introducing CPOE may help to understand the different implementation outcomes.

Enhancement of the superconducting transition temperature in Nb/permalloy bilayers by controlling the domain state of the ferromagnet

In (S/F) hybrids the suppression of superconductivity by the exchange field h(ex) of the ferromagnet can be partially lifted when different directions of h(ex) are sampled simultaneously by the Cooper pair. In F/S/F trilayers where the magnetization directions of the F layers can be controlled separately, this leads to the so-called spin switch. Here we show that domain walls in a single F layer yield a similar effect. We study the transport properties of Ni(0.80)Fe(0.20)/Nb bilayers structured in strips of different sizes. For large samples a clear enhancement of superconductivity takes place in the resistive transition, in the very narrow field range (order of 0.5 mT) where the magnetization of the Py layer switches and many domains are present. This effect is absent in microstructured samples.

ICT in health care: sociotechnical approaches

The importance of the social sciences for medical informatics is increasingly recognized. As ICT requires inter-action with people and thereby inevitably affects them, understanding ICT requires a focus on the interrelation between technology and its social environment. Sociotechnical approaches increase our understanding of how ICT applications are developed, introduced and become a part of social practices. Socio-technical approaches share several starting points: 1) they see health care work as a social, 'real life' phenomenon, which may seem 'messy' at first, but which is guided by a practical rationality that can only be overlooked at a high price (i.e. failed systems). 2) They see technological innovation as a social process, in which organizations are deeply affected. 3) Through in-depth, formative evaluation, they can help improve system design and implementation.

STM imaging of flux line arrangements in the peak effect regime

We present the results of a study of vortex arrangements in the peak-effect regime of 2H-NbSe2 by scanning tunneling microscopy. By slowly increasing the temperature in a constant magnetic field, we observed a sharp transition from collective vortex motion to positional fluctuations of individual vortices at the temperature which coincides with the onset of the peak effect in ac susceptibility. We conclude that the peak effect is a disorder driven transition, with the pinning energy winning against the elastic energy.

Coupling of two superconductors through a ferromagnet: evidence for a pi junction

We report measurements of the temperature dependence of the critical current, I(c), in Josephson junctions consisting of conventional superconducting banks of Nb and a weakly ferromagnetic interlayer of a CuxNi1-x alloy, with x around 0.5. With decreasing temperature I(c) generally increases, but for specific thicknesses of the ferromagnetic interlayer, a maximum is found followed by a strong decrease down to zero, after which I(c) rises again. Such a sharp cusp can be explained only by assuming that the junction changes from a 0-phase state at high temperatures to a pi phase state at low temperatures.

A coherent approach to health informatics education: results of the Dutch curriculum project

From the beginning a coherent approach to health informatics education has been aimed for in our project to develop learning materials. The features are the thematic approach of the contents, the interrelationship of the modules and the didactical approach embedded in the learning materials. Following results have been achieved. Learning materials have been developed for the following themes: healthcare policy and management, delivery of professional care (specific for nursing and allied health), more generic themes such as electronic patient record, clinical decision making, classification and coding of healthcare data and knowledge based systems. Software made available by private companies has been selected for use in the learning modules. In specific cases the available software products did not match the criteria to support the learning materials. In these cases model applications have been developed that can be considered as forerunners for systems in practical use. Already some companies have expressed interest to adapt our home grown products for use in clinical practice. The modules are based on a model curriculum that has been developed by Aarts et al in 1995. New developments in healthcare have prompted modification of the contents of a few modules. For example, a module has been redefined to cover the important issue of logistics in healthcare. The module on patient education has been adapted to take into account the resources available on the Internet. Also, new insights in the effectiveness of computer-based patient education have been taken into account. The module on informatics for disabled persons has been focussed on computer-based aids and is being linked to the EU-project "Impact" aimed at increasing knowledge about assistive technology. However, the model curriculum has proved to be reasonable robust as a base for our project to develop learning materials for health informatics.

Using a descriptive model of change when implementing large scale clinical information systems to identify priorities for further research

In this paper we identify domains for research based on a model that describes the stages of change when designing and implementing large scale information and communication technology throughout a healthcare organization. We use the model in the case of the electronic patient record systems. We suggest that the research agenda should include approaches from the social and business sciences.

Spatially Inhomogeneous Metal-Insulator Transition in Doped Manganites

Scanning tunneling spectroscopy was used to investigate single crystals and thin films of La(1-x)Ca(x)MnO(3) (with x of about 0.3), which exhibit colossal magnetoresistance. The different spectroscopic signatures of the insulating (paramagnetic) and metallic (ferromagnetic) phases enable their spatial extent to be imaged down to a lateral scale of the order of 10 nanometers. Above the bulk transition temperature T(c), the images show mostly insulating behavior. Below T(c), a phase separation is observed where inhomogeneous structures of metallic and more insulating areas coexist and are strongly field dependent in their size and structure. Insulating areas are found to persist far below T(c). These results suggest that the transition and the associated magnetoresistance behavior should be viewed as a percolation of metallic ferromagnetic domains.

Organizational issues in health informatics: a model approach

In this paper, we present a model that describes the stages of the implementation of an information system in a health care organization. The model offers no explanation of the implementation process but rather describes in a cyclic order the domains that are relevant when implementing a system. The model offers thus an opportunity to identify gaps in our knowledge and understanding of implementation processes and provides also the conceptual basis for a higher education course of health informatics that is focusing on organizational change and the pivotal role of information and communication technology.

Exploring factors required for successful implementation of healthcare informatics

This paper examines factors that are essential for a successful implementation of healthcare informatics in professional curricula. These factors are related to the design framework of the learning materials that have been developed as a part of a Dutch model curriculum of healthcare informatics. Next some ideas and suggestions for a successful implementation are presented.

A model curriculum of health care informatics for Dutch higher professional education

This paper describes the results of a two year project to design a model curriculum of health care informatics for Dutch higher professional education. The core of the curriculum are sixteen modules which cover the broad range of medical informatics and which are closely related to the profiles of the professions involved (nursing, physiotherapy, speech therapy, occupational therapy and dietetics). The curriculum emphasizes the need of using structured data and information to perform tasks in health care delivery and management, for which modern information technology is indispensable. The model curriculum will enable faculty to redesign existing undergraduate programs and to select the contents they see appropriate. In this way we hope that the model curriculum will contribute to an innovative attitude of future graduating health care professionals. A new three year project just has started to develop learning materials using professional health care software based on the sixteen modules of the curriculum.

Long-range physical maps of two loci (Aps-1 and GP79) flanking the root-knot nematode resistance gene (Mi) near the centromere of tomato chromosome 6

The root knot nematode resistance gene Mi in tomato has been mapped in the pericentromeric region of chromosome 6. With the objective of isolating Mi through a map-based cloning approach, we have previously identified and ordered into a high-resolution genetic linkage map a variety of tightly linked molecular markers. Using pulsed-field gelelectrophoresis and various rarely cutting restriction enzymes in single, double and partial digestions, we now report long-range physical maps of the two closest flanking markers, acid phosphatase-1 (Aps-1) and GP79, which span over 400 and 800 kb, respectively. It is concluded that the physical distance between both markers is larger than predicted on the basis of genetic linkage analysis. Furthermore, two RFLP markers (H3F8 and H4H10) which map genetically to the same locus as Aps-1 do not show physical linkage, indicating severe suppression of recombination in this region of the chromosome. Finally, no evidence was obtained showing the presence of a CpG island near Aps-1.

Modeling and simulation in biomedicine

A group of researchers and educators in The Netherlands, Germany and Czechoslovakia have developed and adapted mathematical computer models of phenomena in the field of physiology and biomedicine for use in higher education. The models are graphical and highly interactive, and are all written in TurboPascal or the mathematical simulation language PSI. An educational shell has been developed to launch the models. The shell allows students to interact with the models and teachers to edit the models, to add new models and to monitor the achievements of the students. The models and the shell have been implemented on a MS-DOS personal computer. This paper describes the features of the modeling package and presents the modeling and simulation of the heart muscle as an example.